UCSF

CONTEXT: Hyperandrogenism is a hallmark of polycystic ovary syndrome (PCOS), yet the androgen(s) responsible remain ambiguous. Recent studies have suggested that 11-oxygenated C19 steroids (11-oxyandrogens), specifically 11-ketotestosterone, may be a good marker for hyperandrogenism in PCOS. OBJECTIVE: To investigate the utility of 11-oxyandrogens to differentiate women with and without PCOS relative to classical androgens. DESIGN SETTING: Case-control study performed at a PCOS clinic and research center in an academic setting. PATIENTS: 114 women with PCOS and 78 healthy controls. INTERVENTIONS: Using the PCOS Tissue Bank, serum samples and data from 114 women registered from 2013 to 2017 between the ages of 18-40 years, were obtained and classified using Rotterdam PCOS criteria. Data were compared to 78 healthy women of similar age, with serum samples obtained between 2017 and 2020. 11-oxyandrogens and sex steroids were measured using mass spectrometry, and their associations to Rotterdam PCOS, age, and BMI were assessed. MAIN OUTCOME MEASURES: 11-oxyandrogens and sex steroids. RESULTS: Total testosterone, androstenedione, and four 11-oxyandrogens were significantly elevated in women with PCOS compared to age matched controls, controlling for age and BMI (p < 0.01 for all). When considered together, the four 11-oxyandrogens were more predictive of PCOS compared to testosterone and androstenedione. When all androgens were considered individually, 11-ketoandrostenedione was the most predictive of PCOS. Of the six androgens studied, 11-ketotestosterone was the only androgen that demonstrated a weak association with hirsutism score (r = 0.17; p = 0.07) within the PCOS group. CONCLUSION: 11-oxyandrogens were statistically higher in women with PCOS and may serve as better predictors of PCOS than testosterone and androstenedione.